14 World Health • 48th Year, No. 3, Moy-June 1995
Mammography: a woman's perspective •
Cari Borras
B
reast cancer is particularly dreaded because of the mutila- tion it causes. In the USA one woman in eight develops it, in the United Kingdom one in twelve. It is also becoming more common in developing countries, as many of the infectious and parasitic diseases gradually come under control. What is to be done about it? At present the best answer is to detect it early so that it can be treated with minimal surgery, which gives the best cosmet- ic results and the least psychological trauma. If the cancer is discovered in the "preclinical" stage, the proba- bility of cure lasting for at least 20 years is 93%.At present, the only way to make a reliable early diagnosis of breast cancer is with mammography, a specialized radiographic technique for studying the mammary gland.
Because the breast does not contain high density material, such as bones, it is difficult to radiograph. An image produced with the normal technique for a chest X-ray, for example, will show a uniform mass without any detail. Much better results can be obtained with a special X-ray machine using a mammo- graphic technique (see photos).
To detect small lesions, high contrast and resolution are needed.
As in photography, they can be obtained with slow film, which requires a longer exposure. This has to be balanced exactly against the need to keep the radiation dose to a minimum. With the right equipment and procedures, a sufficiently clear and detailed mammogram can be produced. Then, equally impor- tantly, it must be interpreted by a qualified specialist.
The fact that the technical means of controlling breast cancer exist
raises a number of important ques- tions about how they should be used. For instance, are these means available in all countries? Are the physicians who interpret mammo- grams adequately trained? How is the quality of the equipment assured? Who makes sure it is being properly used? Are women aware that they should have a periodic breast examination? Do they practise self-examination?
Radiograph of a woman's breast using an ordinary X-ray machine does not provide the necessary information.
If there is no quality assurance for existing mammography services, perhaps the patients themselves should demand it. Private patients can do this very easily, but what choice do the others have? What should women do to assert their right to survive and to do so with minimal surgery? One strong argument they can use is that a mammography
A mammogram, obtained with a special machine, gives the necessary diagnostic information.
screening programme may be the least expensive screening pro- gramme there is, when one com- pares the cost per mammogram with the number of years of life saved. In terms of action, perhaps women should start by demanding a review of breast cancer incidence in their community and of the health services needed to control it. Such services must include public information and education, as well as diagnosis and treatment.
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Or Cari Borras is Regional Adviser, Radiological Health, World Health Organization Regional Office for the Americas/Pan American Health Organization, 525, 23rd Street N. W., Washington, DC 20037, USA
